Health and the body

Health measures can be set against the same neighborhood ranking that the earlier parts use, and they do not all move together. This part asks which health measures follow neighborhood deprivation, which follow household income when each adult is measured separately, and which follow something else. Many of the neighborhood measures are modeled estimates, and the methods page explains how to read them.

Chapter 5.1, Health behaviors and the supply of care sets many outcomes against census tract deprivation. Measures of health and access rise with deprivation, and the annual checkup rises least, so it does not follow the gradient that the dental visit does. Within states and counties the checkup slope stays near zero. Across tracts within a state, smoking, obesity, diabetes, frequent mental distress and physical inactivity fall as tract income rises, and binge drinking has the opposite sign. The chapter then turns to supply and shows that physicians, dentists and mental health providers are thinner in the counties where deprivation is higher. That association could run in either direction or through a third factor such as rurality, and the studies of coverage and clinic capacity in the chapter do not estimate what a change in supply would do to the county gradients.

Chapter 5.2, Health behaviors, person by person asks whether the neighborhood patterns hold when each adult is measured. A telephone survey that records household income, age, education and race for every respondent shows binge drinking rising with household income while smoking, obesity and physical inactivity fall. The rise holds within age groups, education levels and states and does not appear among non-Hispanic Black adults. The survey places a respondent by state and nothing finer, so the chapter says nothing about neighborhoods, and its person-level results and the tract-level results above come from different measures, so neither confirms the other.

Chapter 5.3, Air pollution asks who breathes the most polluted air, by deprivation, by the Hispanic and Black share of residents and by the grade that the Home Owners' Loan Corporation gave a neighborhood in the 1930s. The sign of the link with deprivation depends on the comparison. Traffic pollution falls as deprivation rises across the country and rises with deprivation within a county. Several pollution percentiles rise with the Hispanic and Black share of a tract in both comparisons, and hazards stack in the same tracts. The indicators are modeled estimates for tracts, and they do not measure what any person breathes.

Chapter 5.4, Multiple chronic conditions asks which chronic conditions are high in the same neighborhoods. Tracts in the most deprived tenth are high on many of the nine conditions it counts and tracts in the least deprived tenth on few, and the conditions move together across tracts, partly because the model behind every estimate shares its inputs. It is a chapter about places and says nothing about how many conditions one person has.